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h <br /> NOTE: PULL ALL PERIMTS (SEPTIC, WELL, ETC...) IOfAKE COPIEESS FOR FILE <br /> LAND USE REPORT APP#jj �TE1 <br /> EHD RECEIVED APP.REFERRAL: COMPLETE & SUBMIT BY �I// /�' <br /> DAT q <br /> ATTN: <br /> SITE ADDRESS: I I (K3 , _�} , L�1hr. �77Gl� YM <br /> In completing the Land Use investigation, draw all Public Health factors on the exhibit (i.e.: sewage disposal, <br /> water supplies, etc...). Where necessary, on an attached piece of plain paper, draw completed map of area <br /> showing population density, location of house, wind direction, etc.... <br /> Public water: Public sewage: <br /> SUMMARY OR COMMENTS: <br /> I recommend: Approval Denial Continuance Inspector's Signature <br /> Supervisor/Lead Senior Comments: <br /> SUPERVISOR/LEAD SENIOR APPROVAL: <br /> OA 77 CHECKOFF LIST., _Proofread report? Correct LAND USE#? <br /> EH 06 06 Rev 1/99 <br /> Correct CONDITION(S)? Logged in LAND USE BOOK? <br />